Heslin Margaret, Forster Anne, Healey Andy, Patel Anita
Centre for the Economics of Mental and Physical Health, King's College London, UK
Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, UK.
Clin Rehabil. 2016 Feb;30(2):119-33. doi: 10.1177/0269215515575334. Epub 2015 Mar 10.
To examine the economic evidence for interventions aimed at family carers of stroke patients.
Searches (limited to those published in English since 1990) were performed in key databases along with hand searches of relevant papers.
Papers were restricted to studies including any economic data (broadly defined) for any intervention targeting carers explicitly or explicitly referring to a carer element, beyond involving carers in the care or intervention for patients (i.e. more than just carers being invited to observe an intervention targeted at the patient). Two reviewers independently screened full papers and extracted data using guidance from the National Institute for Health and Care Excellence, and quality assessment using the Newcastle-Ottawa Quality Assessment Scale (cohort studies), the Delphi list (randomised controlled trials) and guidelines on economic quality from the British Medical Journal. Data were reviewed descriptively as meta analyses were inappropriate due to non-comparability of studies.
Ten papers were included in the review. These were heterogeneous in their design, intervention and economic analyses making comparison difficult. Only three of the ten papers included economic evaluations. All three reported that the intervention was less costly and had better or equivalent outcomes than the control comparator although two of these were based on the same intervention using the same dataset.
There is some limited evidence that interventions for family carers of stroke patients are effective and cost effective. However, due to variation in the types of interventions examined, little can be concluded regarding implications for clinical practice.
研究针对中风患者家庭照料者干预措施的经济学证据。
在主要数据库进行检索(限于1990年以来以英文发表的文献),并对相关论文进行手工检索。
论文限于包含任何经济数据(广义定义)的研究,这些研究针对照料者的任何干预措施明确或含蓄地提及照料者因素,而非仅仅让照料者参与对患者的护理或干预(即不仅仅是邀请照料者观察针对患者的干预措施)。两名综述作者独立筛选全文,依据英国国家卫生与临床优化研究所的指南提取数据,并使用纽卡斯尔-渥太华质量评估量表(队列研究)、德尔菲清单(随机对照试验)以及《英国医学杂志》的经济质量指南进行质量评估。由于研究缺乏可比性,不适合进行荟萃分析,因此对数据进行描述性综述。
该综述纳入了10篇论文。这些论文在设计、干预措施和经济分析方面存在异质性,难以进行比较。10篇论文中只有3篇包含经济评估。所有3篇均报告称,干预措施成本更低,且与对照相比具有更好或相当的效果,不过其中2篇基于相同的干预措施和相同的数据集。
有一些有限的证据表明,针对中风患者家庭照料者的干预措施是有效且具有成本效益的。然而,由于所研究的干预措施类型存在差异,对于临床实践的意义几乎无法得出结论。